الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
T
he current gold standard of care for the majority of patients with severe aortic stenosis is aortic valve replacement (AVR). According to the most recent recommendations from the European Society of Cardiology and the European Association of Cardio-Thoracic Surgery, bioprostheses should be taken into consideration as the preferred course of treatment for patients over 65. Nonetheless, both mechanical and biological valve types are regarded as suitable choices for patients between the ages of 60 and 65. (recommendation class Il-a). As a result, the choice should be founded on a careful examination of other crucial variables. The age range for both types of procedures has been lowered from 60 to 70 years to 50 to 70 years in the most recent publication from the American Heart Association/American College of Cardiology, which emphasizes the value of an informed shared decision-making process between doctor and patient to choose the most practical alternative.
Our study aimed to systematically compare outcomes in elderly patients with surgically implanted mechanical versus biological aortic prosthesis.
A comprehensive literature search was performed using the following search engines, Ovid, Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, and Database of Abstracts of Review of Effectiveness from their dates of inception to 2022.
A total of 4120 patients were analyzed in six articles. Mean age was similar in both groups of patients (61.1 ± 4.3 vs 61.2 ± 4.8 years) in bioprosthetic group and mechanical valve group, respectively. The occurrence of major bleeding was in favor of bioprosthetic valve (less major bleeding) with an odds ratio of 0.73 odd and P<0.001.The occurrence of thrombo-embolic manifestation was in favor of bioprosthetic valve (less stroke) with protective effect by 10%. The effect estimate of OR was 0.9. The need for re-operation was in favor of the mechanical group with an odds ratio of 3.11. The occurrence of mortality is mildly higher in bioprosthetic group compared to mechanical group with an odds ratio of 1.16.
Our analysis therefore supports the current practice of using biological valves for patients who are 60 years of age or older, including renal patients on dialysis, even though longer-term data are anticipated.
CONCLUSION
W
hile choosing a prosthesis type in the clinical practice for patients aged 50 to 70 years, a variety of considerations are taken into account, including the patient’s choice. In this meta-analysis, there was no significant difference between the long-term mortality of the BV and MV groups. Major bleeding and anticoagulant-related events are more likely to occur in MVs than BVs, while reoperation is higher with BVs. Hence, although longer-term data are anticipated, this analysis supports the current practice of using BVs for patients who are 60 years of age or older including renal patients on dialysis.